Application for Enhanced Funding Group How to Complete this Application Please carefully read the following information before completing your application. When completing your application: Print clearly. Complete all sections of the application. Failure to do so may result in a delay in the application process. Make sure the application is signed by the Child Care Program Supervisor/Contact Person (to verify all children s parents are engaged in an approved activity) and the applicable consultant, i.e. Early Interventionist. (see Section F of the application) You can submit your completed application by mail, fax, or in person to: Marina Dichiara, Child Care Service Co-ordinator Child Care Services, Social Services Branch Community and Health Services Department 55 Eagle Street West. Newmarket, ON L3Y 8W5 Phone: (905) 830-4444, Ext. 72459 or Toll-free at 1-877-464-9675, Ext.72459 Fax: 905-895-8377 or email marina.dichiara@york.ca If you require additional information please contact South Community Program Co-ordinator, Jan Saville at Ext. 72662 or email jan.saville@york.ca. Or contact North Community Program Co-ordinator, Darlene Preuten at Ext. 72455 or email darlene.preuten@york.ca Note: You can submit new applications at any time. Applications are date stamped and registered on the wait list by date Funding Approval Process: The Community Program Coordinator reviews all applications, ensures eligibility criteria are met, registers all new applicants on the Wait List, and presents applications to the Review Sub-Committee. The Review Sub-Committee meets a minimum of two times per year to review applications and to make funding recommendations. All funding requests approved by York Region are for a maximum of six months. Funding periods are January to June and July to December. If required, you must re-submit an application to get further funding. Re-application deadline dates are the last week of April and the last week of October. Funding approvals are managed within the approved annual budget. When funding is at capacity, applications are entered on the wait list. The wait list is managed on a first-comefirst-served basis. As funding becomes available, applications on the wait list are addressed, as approved by York Region. Application Checklist Before you submit your application, make sure you have: Completed all sections of the form Obtained the required two signatures in Section F of the application If you do not complete all sections or are missing signature(s), your application may be considered incomplete and will not be processed until the information has been received. Community and Health Services Department Social Services Branch 1-877-464-9675 1
Is this the first time you have applied for Enhanced Funding for the children in this group application? Yes (New Application) No (Re-Application) To be eligible for funding, all parents/guardians of children with exceptional special needs on this application must require child care to support their employment and/or educational needs. Section A Child Care Setting Information Program/Setting Name: Address: City/Town: Postal Code: Mailing Address (if different from above): City/Town: Postal Code: Email: Phone: Fax: Supervisor/Contact Person: Supporting Agency Contact Person: (i.e. Early Intervention Services, Children s Mental Health) Resource Teacher On-Site: Yes No Program Type: Centre-Based Home-Based Section B Group Application Information Age group/classroom that children are enrolled in: Infant Toddler Preschool School Age Kindergarten Total number of children in age group/classroom: Number of staff assigned to group: List the children with identified needs below: Date of Birth (day/month/year) Date of Enrollment Confirmed Diagnosis, if known Indicate if Safety, Health or Mobility Issue Indicate Each Child s Attendance Schedule at Child Care Monday Tuesday Wednesday Thursday Friday Alt. Friday Example: Johnny S. 8-9 a.m. 3-5 p.m. 9 a.m. - 5 p.m. 8-9 a.m. 3-5 p.m. 9 a.m. - 5 p.m. 8-9 a.m. 3-5 p.m. 9 a.m. - 5 p.m. Community and Health Services Department Social Services Branch 1-877-464-9675 2
Section C Plan/Strategies for Safety Document the strategies to be used and the training plan to address the special needs related to safety issues. Johnny S. Susie J. What is the Issue/Need? (specify behaviour that results in a safety issue) bites other children/staff runs out of classroom & playground What Strategies are you Currently Using? redirection provide sensory integration/fidget kit close doors and gates visual supports (STOP signs) What is the Plan of Action? Autism training for staff rotate staff in room for 1 to 1 support during transitions During What Specific Times or Routines is Support Required? free play time 9 to 10 a.m. play time outdoor time Community and Health Services Department Social Services Branch 1-877-464-9675 3
Section C Plan/Strategies for Mobility Document the strategies to be used and the training plan to address the special needs related to mobility issues. What is the Special Need? (that results in a mobility issue) What Strategies are you Currently Using? What is the Plan of Action? During What Specific Times or Routines is Support Required? Tommy J. child is immobile; other children walk over child child is positioned in a safe area of the room closely monitored research strategies, assisted devices, etc. that will support the child with table tasks and floor activities free play time Suzy W. child has visual impairment; a lot of stairs in program child s hand is held when using the stairs rotate staff to implement and practice stair climbing exercise transitions Community and Health Services Department Social Services Branch 1-877-464-9675 4
Section C Plan/Strategies for Health Document the strategies to be used and the training plan to address the special needs related to health issues. What is the Special Need? (that results in a health issue) What Strategies are you Currently Using? What is the Plan of Action? During What Specific Times or Routines is Support Required? Billy T. choking at mealtimes child sits beside teacher encouraged to take small bites of food encouraged to eat a little bit at a time OT consultation meal and snack times Jenny B. child has seizures monitor and observe; implement seizure management techniques First Aid training for Enhanced Funding Worker/all staff ongoing Community and Health Services Department Social Services Branch 1-877-464-9675 5
Section D Community Supports 1. Document all support services currently involved with the children. (first name, last initial Agency Name Contact Person Phone Number Dates of Involvement 2. List past and future training opportunities for staff to support inclusive practices. Type of Training Date of Training Number of Staff Involved 3. Existing supports and resources MUST already have been investigated prior to applying for funds. List all of your contacts/attempts. Agency Name Contact Person Phone Number Dates of Contact Section E Enhanced Funding Request Please check applicable funding period: January to June July to December Funding Start Date: Funding End Date: Total # of days for funding period (add # of days from start to end dates): Total hours required per day: Mon Tues Wed Thurs Fri Alt. Fri Is extra support required on PA days/school breaks? Yes Number of Hours: No Community and Health Services Department Social Services Branch 1-877-464-9675 6
Section F Signatures I hereby, apply for funding services and declare the above information to be true. To the best of my knowledge, all parent(s) of the children identified within this group application are engaged in an approved activity (employment/education/training), and the funding request is consistent with the parent s attendance at work/school. This application will be shared with: a) York Region, Community and Health Services Department, Social Services Branch b) The Child Care Enhancement Committee Child Care Setting Supervisor Signature Date Consultant Signature (i.e. Early Interventionist) Date Enhanced Funding is intended as a short-term measure to help implement strategies for including children with exceptional special needs. Document below how time and supports will be reduced over the duration of the funding period. Community and Health Services Department Social Services Branch 1-877-464-9675 7
Is this the first time you have applied for Enhanced Funding for the children in this group application? Yes (New Application) No (Re-Application) To be eligible for funding, all parents/guardians of children with exceptional special needs on this application must require child care to support their employment and/or educational needs. Section A Child Care Setting Information Program/Setting Name: Address: City/Town: Postal Code: Mailing Address (if different from above): City/Town: Postal Code: Email: Phone: Fax: Supervisor/Contact Person: Supporting Agency Contact Person: (i.e. Early Intervention Services, Children s Mental Health) Resource Teacher On-Site: Yes No Program Type: Centre-Based Home-Based Section B Group Application Information Age group/classroom that children are enrolled in: Infant Toddler Preschool School Age Kindergarten Total number of children in age group/classroom: Number of staff assigned to group: List the children with identified needs below: Date of Birth (day/month/year) Date of Enrollment Confirmed Diagnosis, if known Indicate if Safety, Health or Mobility Issue Indicate Each Child s Attendance Schedule at Child Care Monday Tuesday Wednesday Thursday Friday Alt. Friday Example: Johnny S. 8-9 a.m. 3-5 p.m. 9 a.m. - 5 p.m. 8-9 a.m. 3-5 p.m. 9 a.m. - 5 p.m. 8-9 a.m. 3-5 p.m. 9 a.m. - 5 p.m. Community and Health Services Department Social Services Branch 1-877-464-9675 2
Section C Plan/Strategies for Safety Document the strategies to be used and the training plan to address the special needs related to safety issues. Johnny S. Susie J. What is the Issue/Need? (specify behaviour that results in a safety issue) bites other children/staff runs out of classroom & playground What Strategies are you Currently Using? redirection provide sensory integration/fidget kit close doors and gates visual supports (STOP signs) What is the Plan of Action? Autism training for staff rotate staff in room for 1 to 1 support during transitions During What Specific Times or Routines is Support Required? free play time 9 to 10 a.m. play time outdoor time Community and Health Services Department Social Services Branch 1-877-464-9675 3
Section C Plan/Strategies for Mobility Document the strategies to be used and the training plan to address the special needs related to mobility issues. What is the Special Need? (that results in a mobility issue) What Strategies are you Currently Using? What is the Plan of Action? During What Specific Times or Routines is Support Required? Tommy J. child is immobile; other children walk over child child is positioned in a safe area of the room closely monitored research strategies, assisted devices, etc. that will support the child with table tasks and floor activities free play time Suzy W. child has visual impairment; a lot of stairs in program child s hand is held when using the stairs rotate staff to implement and practice stair climbing exercise transitions Community and Health Services Department Social Services Branch 1-877-464-9675 4
Section C Plan/Strategies for Health Document the strategies to be used and the training plan to address the special needs related to health issues. What is the Special Need? (that results in a health issue) What Strategies are you Currently Using? What is the Plan of Action? During What Specific Times or Routines is Support Required? Billy T. choking at mealtimes child sits beside teacher encouraged to take small bites of food encouraged to eat a little bit at a time OT consultation meal and snack times Jenny B. child has seizures monitor and observe; implement seizure management techniques First Aid training for Enhanced Funding Worker/all staff ongoing Community and Health Services Department Social Services Branch 1-877-464-9675 5
Section D Community Supports 1. Document all support services currently involved with the children. (first name, last initial Agency Name Contact Person Phone Number Dates of Involvement 2. List past and future training opportunities for staff to support inclusive practices. Type of Training Date of Training Number of Staff Involved 3. Existing supports and resources MUST already have been investigated prior to applying for funds. List all of your contacts/attempts. Agency Name Contact Person Phone Number Dates of Contact Section E Enhanced Funding Request Please check applicable funding period: January to June July to December Funding Start Date: Funding End Date: Total # of days for funding period (add # of days from start to end dates): Total hours required per day: Mon Tues Wed Thurs Fri Alt. Fri Is extra support required on PA days/school breaks? Yes Number of Hours: No Community and Health Services Department Social Services Branch 1-877-464-9675 6
Section F Signatures I hereby, apply for funding services and declare the above information to be true. To the best of my knowledge, all parent(s) of the children identified within this group application are engaged in an approved activity (employment/education/training), and the funding request is consistent with the parent s attendance at work/school. This application will be shared with: a) York Region, Community and Health Services Department, Social Services Branch b) The Child Care Enhancement Committee Child Care Setting Supervisor Signature Date Consultant Signature (i.e. Early Interventionist) Date Enhanced Funding is intended as a short-term measure to help implement strategies for including children with exceptional special needs. Document below how time and supports will be reduced over the duration of the funding period. Community and Health Services Department Social Services Branch 1-877-464-9675 7